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General NPI Number Information
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NPI Number | 1619614625
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Entity Type | Individual
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Provider Name | KATHLEEN TRINETTE COSTELLO
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Gender | Female
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 8700 E VISTA BONITA DR STE 188
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3205
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Country | US
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Telephone | 480-506-9747
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Fax |
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Provider Business Mailing Address
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Address Line | 13527 E SUMMIT DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2222
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Country | US
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Telephone | 719-439-0250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC19879
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-19879
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License Number State | AZ
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